Animal-assisted therapy

Animal-assisted therapy (AAT) is an alternative or complementary type of therapy that involves animals as a form of treatment.[1] The goal of AAT is to improve a patient's social, emotional, or cognitive functioning. Advocates state that animals can be useful for educational and motivational effectiveness for participants.[2] In a variety of settings such as prisons, nursing homes, mental institutions, animals are used to assist people with different disabilities. The most commonly used types of AAT are canine-assisted therapy and equine-assisted therapy. AAT is especially helpful in reducing the symptoms of psychological disorders, but most of the effects only last for a short period.

Wilson's (1984) biophilia hypothesis is based on the premise that our attachment to and interest in animals stems from the strong possibility that human survival was partly dependent on signals from animals in the environment indicating safety or threat. The biophilia hypothesis suggests that now, if we see animals at rest or in a peaceful state, this may signal to us safety, security and feelings of well-being which in turn may trigger a state where personal change and healing are possible.[3] A contrast is sometimes made with Animal assisted activity (AAA).[4] AAA is more casual and unstructured than AAT, involving perhaps more than one patient and with the primary focus on the presence of the animal itself. By contrast, AAT includes a handler which together with the animal has been trained for the role. AAT is more structured with specific objectives for each session. However, in common usage terms like these for animal assisted interventions are often used rather loosely.[4]

Assistance dogs can assist people with many different disabilities; they are capable of assisting certain life activities and help the individuals navigate outside of the home.[6]

As with all other interventions, assessing whether a program is effective as far as its outcomes are concerned is easier when the goals are clear and are able to be specified. There are a range of goals for animal assisted therapy programs relevant to children and young people, including enhanced capacity to form positive relationships with others.

Therapists rely on techniques such as monitoring a child's behavior with the animal, their tone of voice, and indirect interviewing. These techniques are used, along with the child's pet or other animal, in order to gain information.[7][non-primary source needed] Before pet therapy can be useful, the child and the animal must first develop a sense of comfort with each other, which is easier to achieve if the child's own pet is used.[7][non-primary source needed] The applied technique that generates the most helpful information about the victim's experience is telling the child that the animal wants to know how they are feeling or what happened.

AAT can be used in children with mental health problems, can be used as a stand-alone treatment or it can be used along with conventional methods.[8] Animals can be used as a distraction method when it comes to various situations or pain, and animals can also help bring happiness, pleasure, and entertainment to the pediatric population. Animals can also help improve children's moods and reinforce positive behaviors while helping to decrease negative ones.[9] Dogs in AAT can be an effective method to reduce pain in children as a complementary treatment.[10][non-primary source needed]

Animal-assistance programs may be useful in prisons to relieve stress of the inmates and workers, or to provide other benefits, but further study is needed to confirm the effectiveness of such programs in these settings.[11]

When elderly people are transferred to nursing homes or LTC facilities, they often become passive, agitated, withdrawn, depressed, and inactive because of the lack of regular visitors or the loss of loved ones.[12] Supporters of AAT say that animals can be helpful in motivating the patients to be active mentally and physically, keeping their minds sharp and bodies healthy.[2] Therapists or visitors who bring animals into their sessions at the nursing home are often viewed as less threatening, which increases the relationship between the therapist/visitor and patient.[13][non-primary source needed]

There are numerous techniques used in AAT, depending on the needs and condition of the patient. For elderly dementia patients, animal assisted therapy provides opportunities to have close physical contact with the animals, which may be helpful for people whose loved ones have passed and who do not frequently receive visitors.[14][non-primary source needed]

There are various animal species used in animal-assisted therapy (AAT). Individual animals are evaluated with strict criteria before being used in AAT. The criteria include appropriate size, age, aptitude, typical behaviors and the correct level of training. The most common forms of AAT are with dogs and horses. There is also published research on dolphin therapy.[15]

In canine-assisted therapy, therapy dogs interact with clients in animal assisted interventions, to enhance therapeutic activities and well-being including the physical, cognitive, behavioral and socio-emotional functioning of clients.[16][17][18] Well trained therapy dogs exhibit the behavior that human clients construe as friendly and welcoming.[18] They comfort clients via body contact.[17] Therapy dogs are also required to possess a calm temperament for accommodating the contact with unfamiliar clients while they serve as a source of comfort.[17] They promote patients engaging in interactions which can help patient improve motor skills and establish trusting relationship with others. The interaction between patients and therapy dogs also aids reducing stressful and anxious feelings patients have.[17] Due to those benefits, canine assisted therapy is used as a complement to other therapies to treat diagnosis such as post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and dementia.[16][18][17]

Canine assistance can also be used in classroom for promoting the development of creative writing and living skills and the participation of children in group activities.[16] There are programs called canine-assisted reading programs which facilitate children with special educational needs. These programs utilize the calm, non-judgmental, happy characteristics of canines to let the process of reading become more meaningful and enjoyable for children. With these benefits, researchers suggest to incorporating dogs into assisting learning and educational programs.[16]

Hippotherapy is promoted as a treatment for people with physical or mental challenges.

A distinction exists between hippotherapy and therapeutic horseback riding. The American Hippotherapy Association defines hippotherapy as a physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes, while the Professional Association of Therapeutic Horsemanship International (PATHI) defines therapeutic riding as a riding lesson specially adapted for people with special needs.[19] According to Marty Becker, hippotherapy programs are active "in twenty-four countries and the horse's functions have expanded to therapeutic riding for people with physical, psychological, cognitive, social, and behavioral problems".[20] Hippotherapy has also been approved by the American Speech and Hearing Association as a treatment method for individuals with speech disorders.[19] In addition, equine assisted psychotherapy (EAP) uses horses for work with persons who have mental health issues. EAP often does not involve riding.[21][22] Additional information pertaining to equine assisted therapy can be seen with Laira Gold's open clinical study of EAT.[23]

Dolphin assisted therapy refers to the controversial alternative medicine practice of swimming with dolphins. This form of therapy has been strongly criticized as having no long term benefit,[24] and being based on flawed observations.[25] Psychologists have cautioned that dolphin assisted therapy is not effective for any known condition and presents considerable risks to both human patients and the captive dolphins.[26] The child has a one-on-one session with a therapist in a marine park of some kind.[27] An ethical issue with data on dolphin-assisted therapy and the effectiveness of it is that most of the research is done by people who operate the dolphin-assisted therapy programs.[27] John Lilly, who studied dolphin-human interaction, first considered this idea that interactions with dolphins can have rewarding benefits on humans in the 1960s.[citation needed]

Based on current research, there are many conditions/disorders that can benefit from animal-assisted therapy (AAT) in diverse settings around the world. Those conditions include psychological disorder, developmental disorder, dementia, cancer, chronic pain, advanced heart failure, etc.[17][15] Animal-assisted therapy is commonly used for psychological disorder. Disorders such as attention deficit hyperactivity disorder(ADHD), autism spectrum disorder(ASD), post-traumatic stress disorder(PTSD), major depressive disorder (MDD) are part of psychological disorders that can benefit from animal-assisted therapy. [8][18][17][15]

In recent decades, an increased number of research indicates the social, psychological, and physiological benefits of animal assisted therapy in health and education field.[16][citation needed] Although the effectiveness of AAT is still unclear due to the lack of clarity regarding the degree to which the canine itself contributes in the recovery process,[17] there is a growing awareness that AAT may be effective in treating attention deficit hyperactivity disorder, post-traumatic stress disorder, autism spectrum disorder, and dementia.

Children with attention deficit hyperactivity disorder (ADHD) may decrease behavioral issues and improve socialization skills with the intervention of AAT. Compared to children only received cognitive-behavioral therapy (CBT), children who received both canine-assisted therapy and cognitive-behavioral therapy (CBT) had reduce in severity of ADHD symptoms.[8][18][17][15] However, the canine-assisted therapy had no effect on relieving ADHD symptoms in long-term treatment.[18]

Animal Assisted Therapy for the Treatment of Trauma in Military Veterans

Post-traumatic stress disorder (PTSD) is a multidimensional diagnosis and is often difficult to diagnose due to varying severity and forms.[28] PTSD is often difficult to treat due to high drop-out rates and low responses to traditional psychotherapeutic approaches and interventions.[29] Alternative approaches, including animal assisted interventions (AAIs), have attracted increased popularity, noting the benefit from comfort animals provide through social and emotional companionship,[30] serving as a complementary or alternative therapy.[31] AAIs are any intervention that incorporates and includes an animal in the treatment process [29][32] and encompass Animal-Assisted Therapy (therapeutic interventions), Animal-Assisted Activities (enrichment activities), and Service/Assistance Animals (i.e., trained animals that assist and support with daily activities).[33] In general, animals can have an overall positive effect on health and can improve mood and quality of life.[29]

Animals have two types of effects, direct and indirect, on a mental health spectrum including biological, psychological, and social responses,[28] further targeting marked symptoms of PTSD (i.e., re-experiencing, avoidance, changes in beliefs/feelings, and hyperarousal) (Johnson et al., 2018). Direct effects of animals include a decrease in anxiety and blood pressure while indirect effects result in increased social interactions and overall participation in everyday activities.[28]

Biologically, specific neurochemicals are released when observing human and animal interactions.[28] For example, the neurotransmitter phenylethylamine is released during a positive interaction between human and animal, further improving mood.[28] Similarly,dog assistance can potentially mediate oxytocin which effects social and physical wellbeing and decrease blood pressure [17]. The psychological benefits of animals focus mainly on dog and human interactions, the reduction of anxiety and depressive symptoms, and increased resilience.[28] Animals in this capacity can further provide emotional and psychological assistance and support, addressing several PTSD symptoms.[28][32] The presence of an animal can alleviate intrusion symptoms by providing a reminder that there is no danger present.[32] Animals can further elicit positive emotions, targeting emotional numbing experiences.[32] Animal interactions also provide social benefits, providing companionship and alleviate feelings of loneliness and isolation through everyday routines and increased social interactions in public.[28][32]

The incorporation and involvement of animals dates back to the earliest forms of organized combat.[28] Dogs, in particular, were utilized in different capacities.[28] Ancient armies employed dogs as Soldiers and companions which extended to modern combat including dogs as a crucial asset in communication, detection, and intimidation.[28] In World War II, dogs were used in therapy as emotional support during the war.[29] While a range of animals can be utilized in AAIs, dogs and horses have been investigated and explored as forms of rehabilitation for veterans suffering from PTSD.[28] Dog assisted therapy and therapeutic horseback riding are non-invasive methods for treating post-traumatic stress disorder (PTSD) in veterans.[17].

Canines can easily integrate into a multitude of environments, are highly responsive to humans, and are very intelligent.[34] For those reasons, dogs are the most common animal used in AAIs.[33] Dogs are typically categorized according to the level of training received and the specific needs of the individual.[33] A service dog provides relief through specialized support related to a physical, mental, or psychological disability.[35] Emotional support animals (ESAs) solely provide psychological relief and do not require specialized training.[35] Therapy animals often provide additional support in a therapeutic environment by supporting counselors or therapists in their therapeutic duties.[35] While service dogs, ESAs, and therapy dogs can support the diverse symptoms that veterans, specifically bred and selected dogs, PTSD Service Dogs (PSDs), are trained and assigned to veterans with PTSD to support with daily life activities [30] as well as with emotional and mental health needs.[28]

Dogs provide subjective positive effects to veterans and serve as a compassionate reminder to veterans suffering from PTSD that danger is not present, creating a safe space for the veteran.[29] They are often sensitive to humans and have the ability to adapt their behavior accordingly by doing tasks such as preventing panic, waking a veteran from a nightmare, and nudging to help the veteran “stay in the present”.[36] Dogs also provide veterans with a nonjudgmental and safe environment that can help a veteran express feelings and process thoughts without interruption, criticism or advice.[37] Interactions, such as petting, playing and walking, with the dog can increase physical activity, reduce anxiety, and provide encouragement to stay in the present moment.[37] The interaction between dog and veterans supports social interactions for isolated veterans, reduces symptoms associated with PTSD such as depression and anxiety, and increases veterans’ calmness.[17]

Similar to dogs, horses have been included in the treatment of veterans suffering from PTSD [33] by providing an accepting and nonjudgmental environment,[31] which further facilitates a veterans’ ability to cope with symptoms associated with PTSD.[31] Because horses are social animals, they are capable of creating and responding to relationships based on the veteran's energy, providing an opportunity for veterans to regain the ability to form trusting relationships.[38] Therapeutic work with horses varies from ground-based activities, mounted activities, or a combination of both.[33] In the therapeutic context, horses can promote cognitive reframing as well as an increase in the use of mindfulness practice.[31] While there is limited research and standardized instruments to measure the effects, veterans who have participated in pilot programs have better communicate skills, self-awareness, and self-esteem,[31] promoting safety and support during the transition into civilian life.[39] Long term effects of equine based interventions with veterans include increased happiness, social support, and better sleep hygiene [33] because they are able to process information regarding their emotions and behaviors in a nonjudgmental space.[39]

While AAIs can be effective, they also have limitations due to limited research and findings on AAIs and veterans with PTSD [29].Furthermore, studies approved yield small sample sizes which limit the power to detect changes [31] as well as the specific tasks that are particularly helpful to veterans.[36] AAT may alsoobstruct veterans from cultivating their own way of control over stressful situation.[citation needed

AAT could reduce the symptoms of ASD such as aggressiveness, irritability, distractibility, and hyperactivity.[8] Therapeutic horseback riding showed positive effects on children with ASD. It increased children's ability of communication and decreased their ASD symptoms. The slow swing motion of horseback riding stimulates the vestibular system and therefore may help children with ASD produce speech sounds.[40][non-primary source needed] Canine assisted intervention provides a calmer environment by reducing the stress, irritation, and anxiety that children with ASD experience.[15][40] Playing with dogs increases the positive mood in children with ASD.[40] Animals also can serve as a social catalyst. In the present of animals, children with ASD more likely engage in social interaction with human.[40] However, the impact of AAT upon parent-child interaction is not clear.[8]

AAT encourages expressions of emotions and cognitive stimulation through discussions and reminiscing of memories while the patient bonds with the animal. A study in 2017 evaluated results from ten research articles and found that animal assisted therapies (particularly using dogs) resulted in measurable quality of life improvements for patients with dementia.[41]

One limitation of pet therapy centers on the application during scenarios that involve adults who have been sexually assaulted. While pets do tend to cause more comfort to victims, pet therapy may not be the catalyst that provides positive success in therapy sessions. As mentioned above, adults tend not to focus as much on having an animal companion, and therefore, pet therapy cannot be attributed as the reason for success in those types of therapy sessions.[5] There are some ethical concerns that arise when applying pet therapy to younger victims of sexual assault. For example, if a child is introduced to an animal that is not their pet, the application of pet therapy can cause some concerns. First of all, some children may not be comfortable with animals or may be frightened, so there would be ethical concerns with using pet therapy, which could be avoided by asking permission to use animals in therapy. Second, a special bond is created between animal and child during pet therapy. Therefore, if the animal in question does not belong to the child, there may be some negative side effects when the child discontinues therapy. The child will have become attached to the animal, which does raise some ethical issues as far as subjecting a child to the disappointment and possible relapse that can occur after therapy discontinues.[5]

Another limitation of animal assisted therapy is that AAT might be a short term reinforce, not a long term one.[citation needed]

The effectiveness of AAT is also still unclear due to the lack of clarity regarding the degree to which the canine itself contributes in the recovery process.[17]

There are some concerns specific to dolphin-assisted therapy: First, it is potentially hazardous to the human patients, and it is harmful to the dolphins themselves; by taking dolphins out of their natural environment and putting them in captivity for therapy can be hazardous to their well-being.[26] Second, dolphin-assisted therapy has been strongly criticized as having no long term benefit,[24] and being based on flawed observations.[25] Third, psychologists have cautioned that dolphin assisted therapy is not effective for any known condition.[26]

Animal-assisted therapy sprouted from the idea and initial belief in the supernatural powers of animals and animal spirits.[citation needed] In modern times animals are seen as "agents of socialization" and as providers of "social support and relaxation".[42] The earliest reported use of AAT for the mentally ill took place in the late 18th century at the York Retreat in England, led by William Tuke.[43] Patients at this facility were allowed to wander the grounds which contained a population of small domestic animals. These were believed to be effective tools for socialization. In 1860, the Bethlem Hospital in England followed the same trend and added animals to the ward, greatly influencing the morale of the patients living there.[43] However, in other pieces of literature it states that AAT was used as early as 1792 at the Quaker Society of Friends York Retreat in England.[44] Velde, Cipriani & Fisher also state "Florence Nightingale appreciated the benefits of pets in the treatment of individuals with illness."

The US military promoted the use of dogs as a therapeutic intervention with psychiatric patients in 1919 at St Elizabeth's Hospital in Washington, DC.

Sigmund Freud kept many dogs and often had his chow Jofi present during his pioneering sessions of psychoanalysis. He noticed that the presence of the dog was helpful because the patient would find that their speech would not shock or disturb the dog and this reassured them and so encouraged them to relax and confide. This was most effective when the patient was a child or adolescent.[45][better source needed]

Some claim that AAT is based on attachment theory,[citation needed] though attachment theory originated in the 1950s and AAT originated earlier (as described above).

Increased recognition of the value of human–pet bonding was noted by Dr. Boris Levinson in 1961.[44] Dr. Boris Levinson accidentally used animals in therapy with children when he left his dog alone with a difficult child, and upon returning, found the child talking to the dog.[7]

^ abcdeFung, Suk-chun (2017). "Canine-assisted reading programs for children with special educational needs: rationale and recommendations for the use of dogs in assisting learning". Educational Review. 69 (4): 435–450. doi:10.1080/00131911.2016.1228611.

^ abNathanson, David E. (1998). "Long-Term Effectiveness of Dolphin-Assisted Therapy for Children with Severe Disabilities". Anthrozoös: A Multidisciplinary Journal of the Interactions of People and Animals. 11 (1): 22–32. doi:10.2752/089279398787000896.